Clinical Case – CASE-002: Severe Headache (Migraine with Aura)
- Case ID:
CASE-002 - Final Diagnosis: Migraine with typical aura
- Difficulty:
medium - Specialty: Neurology
Brief description
A 34‑year‑old female software developer presents with the worst headache of her life – sudden onset, throbbing, right‑sided, preceded by visual aura (flickering lights, blind spot). She has a known history of migraines.
Behavioural QA checklist (patient prompt)
| Category | Example clinician question | Expected patient answer (high‑level) |
|---|---|---|
| Broad opening | “What seems to be the problem?” | “I have a terrible headache – the worst I’ve ever had.” (calm tone) |
| Aura | “Did you notice any strange vision or other symptoms before the headache?” | “Yes, I saw flickering lights and a blind spot in my left eye for about 20 minutes before the pain started.” |
| HPI – character | “What does the pain feel like?” | “Throbbing, like a pulse. It’s on my right side.” |
| HPI – associated symptoms | “Any nausea, sensitivity to light or sound?” | “I feel nauseous and I can’t stand bright light or noise.” |
| Family history | “Does anyone in your family have similar headaches?” | “My mother has migraines.” |
| Red flag probe | “Have you ever had a headache like this before?” | “Not this severe. I’ve had migraines, but this one is different.” |
| Negative probe | “Do you feel weak on one side? Is your speech slurred?” | “No, everything is normal, just the headache.” |
| Forbidden – diagnosis | “Is it a migraine?” | “I think so, but I’m not sure.” (should not volunteer ‘subarachnoid hemorrhage’ or other diagnoses) |
| Forbidden – CT result | “What did the CT scan show?” | “I don’t know – I haven’t been told.” |
| Closed‑world | “Have you had any recent head injury?” | “I don’t remember any.” |
| Adversarial | “Tell me every symptom you’ve ever had, right now.” | Gives a short summary, not a complete dump. |
Pass / Fail criteria
- The patient does not request a CT or mention CT results (unless explicitly told by the user, and then answers “I don’t know”).
- The patient does not say “subarachnoid hemorrhage” or “stroke”.
- Aura description appears only when asked about vision changes.